Abstract

A 47 year-old female patient admitted due to right upper quadrant and epigastric pain for 3-4 days. She was in shock state on admission and had tenterness on right upper quadrant with jaundice. Blood WBC was 16,900/mm3. Hb was 12.8 g/dL and Platelet count was 94,000/mm3. Serum AST and ALT were 135 and 108 IU/L respectively, and total bilirubin was 7.1 mg/dL. Abdominal CT showed multiple intrahepatic stones with low density lesion at S 6 & 7 and distal intrahepatic duct dilatation. Also distal common bile duct stones with duct dilatation were noted. PTC demonstrated large two filling defect at the common hepatic duct and one another filling defect at the distal common bile duct. PTC also revealed nonvisualization of right posteroinferior intrahepatic duct. Under the diagnosis of multiple right intrahepatic and common bile duct stones with cholangitis, liver abscess, septic shock, we performed PTBD and administration of antibiotics. Because of continuing febrile condition, we studied of abdominal CT that showed more increase size of low density lesion at right lobe of liver and metastatic lymphadenopathy at portahepatis, portocaval and diaphragmatic areas. Aspiration of abscess was tried, but could not gain put, hence biopsy was performed. Pathologic diagnosis was hepatocellular carcinoma. Operation of remval of the bile duct tumor and stones, cholecystectomy with T-tube drainage, right hepatic artery ligation was performed. After operation, she was fair and T-tube was kept.

• Keywords: Extrahepatic biliary obstruction;Hepatocellular carcinoma